Providing the best health care to the growing population of foreign-born and non-English speaking individuals in the United States is one of the most important and pressing issues facing health care providers today. While the obvious barrier of language makes communication difficult, there are a myriad of other issues impacting good patient/provider relations – some overt, and others more subtle. Community Voices: Exploring Cross-Cultural Care Through Cancer excels at exploring these issues, using a thematic approach rather than focusing on a particular culture. It is a top-notch teaching tool that emphasizes respect for everyone’s cultural background, valuing the differences between patients and health care providers, and involving all types of community involvement to result in the most informed, high quality health care.

Designed as a discussion starter, it uses cancer as the vehicle to demonstrate the variety of factors impacting the quality of health care - an inspired choice. The issues covered in the program can be applied to any patient/provider interaction, but there are not many diagnoses that invoke the same response no matter what culture, as hearing the word “cancer.”

The Introduction brings up the important questions asked in each segment of the program, with relevant statistics. It is heartening to see that all statistical statements are cited with credible sources. Each part of the video begins with general remarks from Ken Fox, (Pediatrician and Medical Anthropologist) and demonstrated by individual cases voiced by a variety of health care providers. The six other themes include:

Language, Interpretation, and Communication Styles. A visit to the doctor is stressful when a language barrier exists. Physicians and other health care providers use a high level of medical jargon in the U.S. Many patients feel a lack of respect and trust by their physicians and many details of a condition or medication are lost.

Meanings of Illness. Cancer in many cultures equals death. The word itself is scary and conjures negative images. Many cultures rely on spiritual beliefs to explain why cancer occurs (it is God’s will), or many believe that you are paying for unacceptable behavior in life such as drug use or adultery.

Help Seeking. There are a variety of frustrations with the health care industry in the U.S. today. The number of specialists many very ill people need to see is difficult for the most stalwartly American. Other cultures rely on traditional healing methods from herbal remedies to shamans.

Social and Historical Context. It is important to sort out cultural, economic, and social conditions that may affect how a patient approaches health care. Someone making minimum wage and supporting a family may not see a routine visit as a priority.

Core Cultural Issues. Values based on gender, authority, physical contact, religion, and decision-making are extremely vital to understanding views of health care. Many cultures view the Western physician approach of presenting a variety of options to a problem and leaving the decision up to the patient as incompetent. The doctor is the authority and he should know what to do, not the patient who didn’t go to medical school!

Building Bridges. Achieving the highest standard of care for every patient involves many people from the community, such as ministers or priests, community leaders, and even schools.

This quality Fanlight production has the fine technical aspects we have come to expect – clear, well-edited video and sound, and tasteful, unobtrusive music.

Community Voices is a classic and should be required viewing for both health sciences students and practitioners. It is probably more valuable in rural areas where positions such as Medical Interpreters and Medical Anthropologists are not part of the everyday health care team. There are many strengths to this program, but two that stand out the most are its holistic approach to diversity and the masterful inclusion of a variety of ethnicities without singling out any one culture to any extent. Also included is a Facilitator’s Guide that is very well written with learning objectives and discussion points for each theme. It has a valuable reference list with books, articles, videos, and Web sites. Very highly recommended.